MR. LARRY MICHAEL OBORN PA-C NPI 1942219233

NPI Information

NPI: 1942219233
Provider Name: MR. LARRY MICHAEL OBORN, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
11197 W FAIRVIEW AVE
BOISE, ID
ZIP 83713
Phone: (208) 378-8011
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MR. Larry Michael Oborn, PA-C is a medical physician assistant in Boise, ID. MR. Larry Michael Oborn, PA-C NPI is 1942219233. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

11197 W FAIRVIEW AVE
BOISE, ID
ZIP 83713-935
Phone: (208) 378-8011
Fax: (208) 322-8095

The enumeration date for this NPI number is 8/5/2006 and was last updated on 7/8/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	PA11201	CALIFORNIA	No
2	363AM0700X	Physician Assistant	Medical	PA-1099	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	942492609	OTHER	CALIFORNIA	TAX ID NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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